摘要目的 观察光相干断层扫描(OCT)指导重复康柏西普玻璃体腔注射治疗视网膜静脉阻塞(RVO)继发黄斑水肿疗效.方法 回顾性病例研究.临床检查确诊的RVO继发黄斑水肿患者40例40只眼纳入研究.其中,男性19例19只眼,女性21例21只眼.平均年龄(53.58±13.19)岁;平均病程1.5个月.所有患眼均行最佳矫正视力(BCVA)、间接检眼镜、荧光素眼底血管造影(FFA)、OCT检查.患眼平均BCVA0.25±0.18;平均黄斑中心视网膜厚度(CMT)值(509.48±170.13) μm.所有患眼玻璃体腔注射康柏西普0.05 ml(含康柏西普0.5 mg).治疗后连续随访观察6个月.每一个月行BCVA、彩色眼底照相、OCT检查;3、6个月行FFA检查.OCT检查发现视网膜层间及层下积液或CMT值较之前最低CMT值增加≥50μm给予再次康柏西普玻璃体腔注射治疗.对比观察治疗前后BCVA、CMT值变化,以及与药物和治疗方式相关的并发症发生情况.结果 治疗后6个月,40只眼中,BCVA提高、稳定、下降分别为25、13、2只眼,分别占62.5％、32.5％、5.0％.所有患眼视网膜出血及渗出大部分吸收.FFA检查,视网膜血管无荧光素渗漏11只眼,占27.5％;轻微荧光素渗漏26只眼,占65.0％;视网膜毛细血管无灌注区形成3只眼,占7.5％.OCT检查,视网膜层间及层下弱反射暗腔消失或减少,平均CMT值为(235.20±100.44) μm.平均玻璃体腔注射次数为2.85次.其中,行2、3、4次玻璃体腔注射分别为14、18、8只眼,分别占35.0％、45.0％、20.0％.所有患者治疗过程中及治疗后均未见明显与药物、玻璃体腔注射相关的眼部和全身不良事件的发生.结论 OCT指导重复康柏西普玻璃体腔注射治疗RVO继发黄斑水肿安全、有效,能稳定或提高患眼视力.

abstractsObjective To evaluate the effectiveness of repeated intravitreal conbercept injection in patients with macular edema (ME) of retinal vein occlusion (RVO),guided by optic coherence tomography (OCT).Methods It is a retrospective case study.Forty patients (40 eyes) diagnosed as ME secondary to RVO were enrolled in this study.There were 19 males (19 eyes) and 21 females (21 eyes),with the mean age of (53.58 ± 13.19) years and the mean course of 1.5 months.The best corrected visual acuity (BCVA),indirect ophthalmoscopy,fundus fluorescein angiography (FFA) and OCT were performed.The mean baseline of BCVA,central macular thickness (CMT) were 0.25 ± 0.18 and (509.48 ± 170.13) μm respectively.All the patients were treated with 10.00 mg/ml conbercept 0.05 ml (including conbercept 0.5 mg).Follow-up of these patients was 1 to 6 months after treatments,the BCVA,fundus manifestations,OCT were retrospectively observed by every month,the FFA was retrospectively observed by every 3 months.When there was retinal edema or CMT ≥ 50 μm by OCT during follow-up,those patients were retreated with intravitreal conbercept injection.The changes of the BCVA,CMT were evaluated before and after treatment.Meanwhile,complications in eyes related to medicine and treatment methods were evaluated too.Results At the 6 months,the BCVA was improved (increase≥2 lines) in 25 eyes (62.50％),stabilized (± 1 line) in 13 eyes (32.50％) and decreased 2 lines in 2 eyes (5.00％).Retinal hemorrhage and exudates were absorbed in most patients.FFA showed no fluorescein leakage in 1 1 eyes (27.50％),minor fluorescein leakage in 26 eyes (65.00％),and retinal capillary non-perfusion in 3 eyes (7.50％).OCT showed absorption of the subretinal fluid.The mean CMT were (235.20± 100.44) μm at 6 months.Intravitreal injection of conbercept was applied for 4 times in 8 eyes (20.00％),3 times for 18 eyes (45.00％),and 2 times for 14 eyes (35.00％).The mean number of intravitreal injection was 2.85 times.There were no ocular or systemic adverse events observed in all patients.Conclusion Intravitreal conbercept injection is an efficacy and safe treatment for the patients with ME of RVO guided by OCT.It can stabilize and improve the visual acuity.